Digital Commons Network^™

Cholesterol Efflux Capacity And Its Association With Metabolic Syndrome In A Multi-Ethnic Population (Dallas Heart Study): A Cross-Sectional Study, Oludamilola Akinmolayemi

Dissertations & Theses (Open Access)

Metabolic syndrome (MetS) is a multi-component risk factor for cardiovascular disease (CVD) and type 2 diabetes. MetS has been found to be associated with increased risk of incident CVD, cardiovascular morbidity and mortality, and prevalence atherosclerosis. Cholesterol efflux capacity (CEC) is a measure of the functional property of high-density lipoprotein cholesterol (HDL-C). In addition, it characterizes the ability of HDL-C to accept cholesterol from extra-hepatic cells in the periphery to the liver and has been shown in clinical studies to be inversely associated with atherosclerosis cardiovascular disease (ASCVD) and incident cardiovascular disease (CVD) . Low HDL-C is one of the …

Factors Affecting Antiretroviral Treatment Entrance, Adherence And Retention Among Hiv Patients In Nigeria And Uganda, Nnenna Ananaba

Dissertations & Theses (Open Access)

Introduction: The maximum benefits of antiretroviral therapy (ART) are achieved when HIV patients follow through the HIV Care Continuum. Understanding the factors that impact the Care Continuum are key in minimizing late ART uptake while increasing treatment retention and adherence in sub-Saharan Africa. Objectives: To explore factors that impact the various phases of the HIV Care Continuum, we review trends in median CD4 cells count and presentation with HIV advanced disease stage between 2013 and 2017. We also examined treatment retention rates and the impact of food security on ART adherence. Methods: Two datasets were reviewed. One dataset consists of …

Patient-Perceived Patient-Centered Medical Home Characteristics And Healthcare Utilization, Expenditure And Quality, Alissa Ratanatawan

Dissertations & Theses (Open Access)

The patient-centered medical home (PCMH) model is a care delivery model which patient treatment is coordinated through their primary care physician to ensure they receive the necessary care when and where they need it, in a manner they can understand with the aims to improve healthcare quality while keeping healthcare cost growth under control. The objective of this study was to analyze health service utilization, expenditure and quality of civilian noninstitutionalized US adult population in healthcare facilities that have 3 domains of PCMH features, which are comprehensive care, patient-centered care, and accessible care, using patient’s perspective from the 2016 Medical …

Clinical And Demographic Factors Associated With Peg-Asparaginase-Related Toxicities In Patients With Acute Lymphoblastic Leukemia, Priyadarshani Dharia

Dissertations & Theses (Open Access)

Introduction: Polyethylene glycol (PEG)-asparaginase is one of the first-line drugs in pediatric ALL treatment. Although a complete and prolonged treatment with PEGasparaginase has been instrumental in improving the survival of ALL patients, it is associated with four common toxicities: hypersensitivity, hyperbilirubinemia, pancreatitis, and venous thromboembolism (VTE). PEG-asparaginase-related toxicities may require modifications and delays in treatment, which often leads to poor treatment outcomes. Previous studies of PEG-asparaginase-related toxicities have mainly focused on individual toxicities. Further, these studies were conducted in study populations which were predominantly self-reported non-Hispanic whites. Therefore, there is a gap in the knowledge regarding the cumulative burden of …

Physical Activity Among Preschool-Aged Children: Considerations For Waking Activity Patterns And Health, Erin Dooley

Dissertations & Theses (Open Access)

With nearly one-quarter (23%) of U.S. preschool children (ages 3-5 years) having overweight or obesity, supporting healthy growth and development is paramount. Hispanic children have the highest prevalence within this age group (15.6%) and a large projected population growth. Energy expenditure through physical activity is one way to combat excess development of obesity and poor health outcomes. Yet there is limited evidence about the correlates associated with physical activity and health within this population. The three studies of this dissertation examined sociodemographic-, cultural-, and context-related factors related to waking activity patterns and the subsequent impact on health indicators. The overall …

Examining The Relation Between Social Capital And Physical Activity Across Life Stages, Leigh Ann Ganzar

Dissertations & Theses (Open Access)

Physical inactivity in adults increases the risk for adverse health outcomes, including non-communicable diseases and premature death. Children who are not sufficiently physically active face increased risk for non-communicable disease risk factors, mental health issues, and poor academic performance. Despite these risks, the majority of people do not achieve sufficient physical activity levels. Social capital is an aspect of the social environment that can shape physical activity behavior throughout different life stages. The three studies of this dissertation sought to assess the association between social capital, from both the cohesion and network perspectives, and physical activity behavior in different life …

Additional Graduate Degrees Associated With Promotion Among Primary Care Clinical Faculty, Michael A. Hansen

Dissertations & Theses (Open Access)

Introduction: Many young and ambitious physicians purposefully seek out meaningful careers in academic medicine, yet there are no evidence-based findings to assist these individuals in how to succeed in advancing their careers in this unique work environment. For early and mid-career faculty, a growing number of trainings and opportunities are available but with little insight as to which choices may have the biggest impact. One common perception is the need for additional advanced training, such as a Master of Public Health. Aims and Method: This study sought to provide evidence-based information about additional training by quantifying the benefit of added …

The Associations Between Fat And Clinical Outcomes Among Lung Cancer Patients: Dietary Intake And Genetic Determinants, Fang Yu Lin

Dissertations & Theses (Open Access)

Higher dietary fat intake and alterations in fatty acid metabolism may affect cancer development and progression. This dissertation conducted a series of studies examining whether dietary fat intake and genetic variants in fatty acid metabolism genes have an impact on clinical outcomes among non-Hispanic whites newly diagnosed with non-small cell lung cancer (NSCLC). First, a cohort of 2,262 NSCLC patients was prospectively examined for intakes of total, saturated, monounsaturated, and polyunsaturated fat in relation to overall survival and recurrence. Dietary fat intake at diagnosis was assessed with a previously validated food frequency questionnaire and categorized by Dietary Reference Intakes. Multivariable …

Access To Antibiotics Without Prescription For Travelers And Colombian Citizens At Community Pharmacies In Bogota, Colombia, Marie Kasbaum

Dissertations & Theses (Open Access)

The misuse of antibiotics has been shown to exacerbate the global antibiotic resistance crisis, which could have major consequences on public health worldwide (Auta et al., 2018). In Bogotá, Colombia, the non-prescription sale of antibiotics still occurs in pharmacies despite national regulations requiring a prescription from a physician or health agency before dispensing antibiotics to a patient (Vacca et al., 2011). The purpose of this study was to investigate the non-prescription sale of antibiotics in community pharmacies to foreign travelers and Colombian citizens in Bogotá, Colombia. Trained Simulated Clients (SCs) gathered experimental data in pharmacies distributed throughout 20 geographic districts …

Examining Differences In Physical Activity By Socio-Demographics, Employment, And Social Support Among U.S. Adolescents, Ashleigh Marie Johnson

Dissertations & Theses (Open Access)

The overall decline in physical activity levels during adolescence supports the examination of intrapersonal-, interpersonal-, and behavior-level factors that may influence physical activity behavior among this population. The three papers within this dissertation aimed to examine associations of socio-demographics and socio-environmental factors with physical activity among U.S. adolescents. Papers 1 and 3 used data from the Family Life, Activity, Sun, Health, and Eating (FLASHE) Study. Paper 1 examined differences in adolescent physical activity by gender and race/ethnicity, and examined modification by grade and socioeconomic status (SES). Paper 3 examined the association of parent- and adolescent-reported parental social support with adolescent …

Understanding The Relatlonships Between Survivorship Care Plans And Survivor Level Outcomes Among Breast And Colorectal Cancer Survivors, Jessica Danielle Austin

Dissertations & Theses (Open Access)

PURPOSE: Cancer survivors have complex journeys following the completion of active treatment. The Institute of Medicine and other high-profile organizations have recommended and mandated the use of a survivorship care plan (SCP) despite mixed evidence supporting the impact of SCPs on key survivor-level outcomes. The purpose of this dissertation was to understand the complex relationship linking the delivery of SCPs and to relevant survivorlevel outcomes. STUDY GROUP: This dissertation focuses on breast and colorectal cancer survivors because they comprise nearly 30% of the entire cancer survivor population in the US and are the two most prevalent cancers in men and …

Insuring The Integrity Of Global Registries, Aardhra Meenakshi Venkatachalam

Dissertations & Theses (Open Access)

Data quality is a priority in public health because it is used for public health program planning and implementation, research, as well as policy. The information gleaned from the data allows us to assess health status, and improve health needs. This paper evaluated methods for cleaning, managing and addressing missing data in the Lagos State Ambulance Service registry. The techniques included screening, data organization, diagnostic phase, treatment phase and a missing data phase to holistically handle the data. The percentage of systemic errors was reduced through the use of the 5-step method. Missing data was informative for state of origin, …

Ashtanga For Addiction: A Qualitative Web-Based Open-Ended Survey To Assess Outcomes From Ashtanga Yoga Practice In Individuals In Long-Term Recovery From Substance Abuse Disorder, Shaun M. Jones

Dissertations & Theses (Open Access)

Over 72,000 people die from overdose or secondary health issues related to substance use disorder (SUD) annually. Studies support mind-body interventions in reducing stress, anxiety, depression, and craving symptoms. There is a growing body of literature supporting yoga as a mind-body intervention for individuals recovering from SUD. These interventions promote improved physical awareness, greater awareness of mental states, non-reactivity, and reduced perception of pain, allows for more successful coping with cravings. Ashtanga yoga (AY) is a tradition of yoga wherein students work on a one-on-one basis with highly qualified teachers following an invariant sequence of yoga postures. AY is characterized …

Perceived Discrimination From Providers On Latina Mothers’ Decision-Making On Hpv Vaccination Initiation And Completion In Houston, Tx, Fatima Frausto

Dissertations & Theses (Open Access)

Background: Human papillomavirus (HPV) is one of the most common sexually transmitted infections (STI) in the United States (US). Certain HPV strains have the potential to develop into cervical, anal, penile, vulvar, and throat cancers. Latinos in the U.S. have the highest rates of cervical and penile cancers compared to non-Hispanic Whites. Despite the availability of HPV9v, uptake of the vaccine is suboptimal in the Latino community. Previous research has found factors such as provider recommendation and communication are important in HPV vaccine series initiation and completion. Discrimination in the medical setting is linked to poorer health outcomes and delayed …

“He’S Not Too Young”: Empowering Parents In Child Language Development Through Upwords, A Parenting Education Program, Lynda Chima Aririguzo

Dissertations & Theses (Open Access)

Community-based early literacy intervention programs show promise in improving the home language environment, particularly for children at increased risk of language delays and poor school readiness. However, the literature on parents’ perspective of these programs is limited. This study investigated the perspectives and language scores of participants in upWORDS, a community-based literacy intervention program in Houston, TX. Through mixed-methods, this study aimed to describe the program’s impact on parents’ views on child development, changes in child behaviors, and continued application of information from the program. It also aimed to identify patterns in parent-reported measurements of children’s language skills over time. …

The Impact Of Food Security Status On The Food Shopping Behavior And Patterns Of 2018 Brighter Bites Participants At Baseline, Sarah A. Crulcich

Dissertations & Theses (Open Access)

Households with children continue to have a greater prevalence of food insecurity compared to the national average. While the national food security rates have improved in recent years, it remains stagnant among children. The purpose of this study was to conduct a cross-sectional regression analysis on food shopping patterns and behavior among Brighter Bites participants stratified by food security status to offer more insight into how these households obtain fresh produce. We used baseline survey data from Brighter Bites participants completed during fall 2018. The results indicate that food insecure Brighter Bites households shop more frequently for produce at locations …

Evaluation Of Food Journal Application Validity In Comparison With Dhq Iii, Michael Roa

Dissertations & Theses (Open Access)

As chronic conditions associated with the high prevalence of obesity/overweight in the United States continue to rise, research focusing on nutrition has grown in recent years. The gold standard for collecting detailed nutritional information on individuals is food journals, mostly via pen and paper. Alternatively, smartphone food journal applications have become more popular and widely accessible in recent years. These applications allow the user to quickly make meal entries, often taking advantage of the application’s food and servings database.

This study compared the results of the third iteration of the Diet History Questionnaire (DHQ III) with a dietary journal data …

Hepatitis C Infection In Men Who Have Sex With Men, Jing Zhao

Dissertations & Theses (Open Access)

Hepatitis C virus (HCV) infection is the leading cause of cirrhosis, hepatocellular carcinoma, and liver transplantation. Current treatment rates and efficacy are inadequate to manage the disease burden caused by HCV; thus, efforts are needed to control HCV transmission. Besides the well-known transmission routes, which are health-care-associated transmission and transmission through injecting drugs, HCV could also be transmitted by sexual contact, especially among men having sex with men (MSM). MSM also have higher drug use prevalence than the general population, which may contribute to HCV infection by sexual disinhibition and other risky behavior. Since 2000, there have been emerging reports …

Novel Propensity Score Methods For Multiple And Continuous Treatments: Applications To Ehr Data, Derek W. Brown

Dissertations & Theses (Open Access)

Propensity scoring is often utilized to overcome the challenges posed by covariate imbalance to make causal inferences within observational studies. While methods for utilizing propensity scoring in a binary treatment case are well studied and established, generalizations to multiple unordered (multinomial) and continuous treatments are more complicated. In Aim 1, we developed and tested a novel multinomial treatment propensity score method, the GPS-CDF method, which derives a single scalar balancing score that can match and stratify subjects. Simulation results showed superior performance of the new methodology compared to standard multinomial propensity score methods. The proposed GPS-CDF method was also applied …

Concurrent And Concordant Oral And Genital High Risk Human Papillomavirus Infections In The United States Population; Results From National Health And Nutrition Examination Survey (Nhanes), James M. Custer

Dissertations & Theses (Open Access)

Human papillomavirus (HPV) is a common sexually transmitted disease which infects various sites in the body including the genitals, oral cavity, and anal regions. Very little research has assessed the prevalence of concurrent and concordant high risk (HR) HPV oral and genital infections in the general United States population despite the fact that HR HPV oral pharyngeal cancers are on the rise in the US, particularly in men. To further our understanding of HR HPV concurrent and concordant infections we aim to estimate the prevalence of HR HPV concurrent and concordant infections in the U.S. population, and for men and …

Assessing Hospitalizations Due To Assaults At Dell Seton Medical Center (2015-2018), Stephani L. Curry

Dissertations & Theses (Open Access)

Physical assaults are a major public health concern in the United States, with rates being on the rise during the last couple of years (WISQARS Nonfatal Injury Reports, n.d.). In Austin at the Dell Seton Medical Center [DSMC], physical assaults are a main reason for hospitalization, making up nearly 10% of their hospitalizations, with around 250 patients per year. No subgroup of the population is risk free from physical assaults; however, national data suggest some sociodemographic groups are at higher risk than others (“Injury and Violence Prevention”, n.d.). Given the diversity of Austin, TX, it was unclear whether local sociodemographic …

Assessing The Impact Of Environmental Factors On Sedentary Behavior, Brandy Baker

Dissertations & Theses (Open Access)

Objectives Mexican Americans are burdened with many of the same noncommunicable diseases present in sedentary populations. Those living on the Texas/Mexico border have higher rates of obesity and diabetes than others in the nation. Sedentary behavior and perceptions of the environment have not been well studied among Mexican Americans, especially when examining education, gender and age. Study Design Sample was drawn from the Cameron County Hispanic Cohort (CCHC) where participants were randomly selected and completed a survey to report sedentary behavior and perceptions of the environment among other examinations. The participants’ initial visit with the CCHC was included in the …

Validation Of The Conflict In Adolescent Dating Relationships Inventory (Cadri) In Young Adolescents: An Analysis Of Construct Validity And Measurement Invariance, Stephanie J. Stroever

Dissertations & Theses (Open Access)

Adolescent dating violence, defined by the Centers for Disease Control and Prevention as “physical, sexual, psychological, or emotional aggression within a dating relationship, including stalking,” among adolescents in intimate relationships is a serious public health concern (Centers for Disease Control and Prevention, 2018). Per the 2017 national Youth Risk Behavior Surveillance (YRBS) survey of high school students in the United States, 10.7 percent of females and 2.8 percent of males that reported a romantic relationship in the prior 12 months experienced sexual dating violence (Kann et al., 2018). Additionally, 9.1 percent of females and 6.5 percent of males reported physical …

Protective Or Destructive? Investigating The Relationship Between Gentrification And Childhood Health Outcomes, Mike Henson Garcia

Dissertations & Theses (Open Access)

Gentrification is a wildly contentious, highly politicalized issue that some scholars view as beneficial and others view as harmful. Historically, public health researchers have studied several neighborhood effects on health but only recently has this research field evolved to include studies specifically looking at the health ramifications associated with this neighborhood-change process. This secondary analysis is one of the first studies to examine the effect neighborhood-level gentrification has on mental health status in a childhood and adolescent sample. Results find that no main effect exists between gentrification and mental health problems directly. However, a statistically significant interaction-- between gentrification and …

Additional Healthcare Expenditures Of Depression For Elderly Cancer Patients With Depression, Dian Gu

Dissertations & Theses (Open Access)

The risk of depression is high for cancer patients and a large portion of cancer patients are age 65 and over. Both depression and cancer are economically burdensome and depression is associated with healthcare expenditure increase for elderly patients. However, whether comorbid depression affects healthcare expenditures in elderly cancer patients from payers’ and patients’ perspectives is largely unknown. Objective: To investigate whether depression is associated with higher healthcare expenditure among elderly cancer patients from both payers’ and patients’ perspectives and, and determine whether depression is associated with higher probability of having high out-of-cost burden. Methods: From the Medicare Current Beneficiary …

A Bundled Payment Profile For Head & Neck Cancer: Descriptive Statistics, Risk Assessment, And Pricing Recommendations For 1 Year Treatment Bundles Using A Large National Claims Database, Alexis Barboza Guzman

Dissertations & Theses (Open Access)

Bundled payments have the opportunity to promote care standardization and coordination while incentivizing efficiency and value-based healthcare delivery. However, bundled payments have been scrutinized due to challenges with defining the bundled lengths (also known as the episode of care period), limited inclusion/exclusion criteria, the absence of IT systems to support new payment models, and the lack of federal support. The objective of this study was to develop a profile for head and neck cancer, including descriptive statistics, risk assessment and bundled payment pricing recommendations using a large national claims database. The ability to assess pricing risks associated with head and …

The Association Between Sleep Duration And Dementia: A Meta-Analysis, Sherri Hong

Dissertations & Theses (Open Access)

In the United States, the current cases of Alzheimer’s disease will double by 2050. Therefore, it is important to study risk factors associated with dementia such as sleep duration. This meta-analysis was conducted to understand the discrepancy in study results since some demonstrated a V shaped association between duration of sleep and dementia while others found no association. If there truly is an association then sleep duration could be targeted to decrease the burdens caused by dementia. A meta-analysis of published studies was conducted to assess the association between sleep duration and the different forms of dementia. The articles were …

The Prevalence Of Practicing Safety Professionals’ Knowledge, Involvement, And Competency Associated With Workplace Wellness Programs: Gauging The Safety Profession’S Engagement With The Total Worker Health Initiative, Jennifer C. Laine

Dissertations & Theses (Open Access)

The morbidity and mortality burden of occupational injuries and illnesses in the United States became such a public health concern that in 1970 the Occupational Safety and Health Act was signed into law. This law requires employers to provide workplaces “free from recognized hazards” and spurred the development of specific regulations along with the creation of academic and professional training programs to educate individuals about the safety sciences and careers in safety fields. Today there are an estimated 26,000 professionally trained and board certified safety professionals supporting workplace programs across the country, alongside numerous non-certified, but degreed, practicing safety professionals. …

Women In Leadership: A Qualitative Review Of Challenges, Experiences, And Strategies In Addressing Gender Bias, Brynn Harris

Dissertations & Theses (Open Access)

Women are entering the workforce at an increasing rate, yet they are still drastically underrepresented in leadership positions. The primary research question addressed in this study was two-fold: what challenges have women faced in pursuit of leadership positions, and how have these women overcome these challenges to achieve success? While quantitative research has ventured into determining why there is still such a large gender gap in leadership positions, this study aimed to better understand the actual life experiences of successful female leaders. In this study, twenty-six women who hold – or recently held – significant leadership positions participated in qualitative …

A Retrospective Analysis Of Claims Data To Determine Symptoms Associated With Ovarian Cancer, Denise Manon Langabeer

Dissertations & Theses (Open Access)

According to the American Cancer Society, approximately twenty percent (20% of women with ovarian cancer are diagnosed at an early stage (e.g. stage I or II), which subsequently means eighty percent (80%) of women diagnosed with this disease are at the late stage (e.g. stage III or IV) and are likely not to survive. No cure exists and, concurrently, studies show mixed results in utilizing blood tests and transvaginal ultrasounds to screen for ovarian cancer. While symptoms are not easily discernable, some oncologists have validated there are common symptoms women experience prior to diagnosis. As these symptoms are not routinely …